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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609856
Report Date: 07/31/2025
Date Signed: 07/31/2025 03:56:52 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/24/2024 and conducted by Evaluator Perchui Khurshudyan
COMPLAINT CONTROL NUMBER: 31-AS-20240924123647
FACILITY NAME:WESTFIELD SENIOR LIVINGFACILITY NUMBER:
197609856
ADMINISTRATOR:BALASANYAN, MARIAMFACILITY TYPE:
740
ADDRESS:7633 MASON AVETELEPHONE:
(818) 384-1134
CITY:WINNETKASTATE: CAZIP CODE:
91306
CAPACITY:6CENSUS: 5DATE:
07/31/2025
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Armine Kiseleva - CaregiverTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Resident sustained pressure injuries while in care.
INVESTIGATION FINDINGS:
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On 7/31/2025, Licensing Program Analyst (LPA) Perchui Milena Khurshudyan conducted a subsequent complaint visit at this facility to conclude the investigation regarding the above allegation and to deliver the final report. Upon arrival LPA met with the Staff/Caregiver Armine Kiseleva and explained the reason for the visit. Entrance interview conducted.

During the initial visit on 9/25/24, LPA Khurshudyan conducted interviews and records reviews. At 10:25am, LPA requested resident and staff rosters. LPA also requested copies of pertinent information which include, but not limited to Admission Agreement, Physician’s Report, Appraisal Needs and Services Plan, copies of Incident Reports, R1’s hospice records, and additional documents relevant to the investigation. At approximately 10:10am, LPA conducted a physical plant tour, to ensure health and safety of the residents are protected and physical plant is in compliance with Title 22 Regulations. Between 10:15am – 2:00pm, LPA interviewed the Administrator, two (2) staff members and two (2) out of four (4) residents, who were able to communicate.
Continue on 9099-C

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Perchui Khurshudyan
LICENSING EVALUATOR SIGNATURE:

DATE: 07/31/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 31-AS-20240924123647
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: WESTFIELD SENIOR LIVING
FACILITY NUMBER: 197609856
VISIT DATE: 07/31/2025
NARRATIVE
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During today’s visit, LPA requested copies of resident and staff rosters. At approximately 2:15pm, LPA conducted a physical plant tour, to ensure health and safety of the residents are protected.

Allegation: Resident sustained pressure injuries while in care.

It was reported that R1 sustained pressure injuries while receiving care and that the reporting party did not know when the wounds occurred or if the resident was on hospice. The RP also mentioned that R1 did not have any wounds before being placed at the facility. To investigate the allegation LPA conducted thorough review of facility records, hospice agency documentarians, wound care specialist visitation notes, as well as interviews with the facility administrator, two (2) caregivers, and the following were obtained. R1 got admitted to the facility on 8/24/22. Records review revealed that R1 got admitted under hospice care on 11/18/2022 with full consent and agreement from RP. According to the records, R1 developed stage 3 pressure injuries in early October of 2023 and wound care treatment was initiated immediately on 10/6/23. Wound care services were provided in coordination with the hospice agency and a wound care specialist. LPA reviewed records and noted consistent wound assessments, treatment updates, and ongoing monitoring of R1’s condition. Interviews with all staff members confirmed that the facility followed all required protocols, including timely notification of hospice, wound care orders, repositioning R1 every one (1) or two (2) hours, and regular communication with RP. There was no delay in addressing R1’s skin condition, and care was provided in accordance with regulatory requirements. As RP did not specify when the wounds allegedly occurred and was uncertain if R1 was receiving hospice services at that time, the investigation confirms that hospice services were in place and pressure injuries were treated promptly. The interview with two (2) residents confirmed that caregivers do provide adequate care and supervision to all residents and that they witnessed the proper care R1 received while residing in the facility. Residents also stated that RP was visiting R1 frequently, RP was aware of R1’s health condition, and was always thanking caregivers for the best service R1 receives in the facility.

Based on the observation, records review, and interviews, there is insufficient evidence to support the allegation that the facility staff neglected care to R1 and failed to provide proper care resulting in pressure injuries. Therefore, the allegation is deemed Unsubstantiated at this time.


Exit interview conducted and report signed and delivered.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Perchui Khurshudyan
LICENSING EVALUATOR SIGNATURE:

DATE: 07/31/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2